DESCRIPTION: The huge toll caused by back injuries among nursing home workers has been well documented at both the national and state level. These injuries have been primarily related to patient/resident handling activities. There is strong evidence that reduction in low back load would reduce the risk for injury. Zero-lift programs are designed to reduce these back loads and involve several components, some of which include: training; lifting devices; management enforcement of zero-lift policies; employee and management cooperation and participation; and injury investigation and management. Training materials and mechanical lifting devices continue to be developed and improved, yet back injuries are still occurring in nursing homes at an unacceptably high rate. The challenge for the nursing home industry is to effectively implement programs that reduce the physical load on nursing assistants, while maintaining a safe and caring environment for the residents of the nursing homes. The goal of this intervention effectiveness study is two-fold. The first is to evaluate the successful implementation of zero-lift type programs in nursing homes in Washington State after distribution of zero-lift program training materials by the Washington Health Care Association to 75% of Washington State nursing homes. In addition, two workers' compensation incentive pilot programs for the implementation of zero-lift programs in a small subset of nursing homes will be evaluated. The second goal is to evaluate the effectiveness of these programs in reducing the incidence and severity of low back and shoulder injuries in nursing assistants in nursing homes that are caused or aggravated by resident handling activities.